# Nutritional and inflammatory biomarkers predicting hospitalization length in acute decompensated heart failure EF below 50%

## TL;DR

This study found that nutritional and inflammatory biomarkers can predict hospitalization length in patients with acute decompensated heart failure and reduced ejection fraction.

## Contribution

The study identifies specific biomarkers that predict hospitalization duration in acute decompensated heart failure patients with LVEF <50%.

## Key findings

- Higher HALP and PNI were independent predictors of shorter hospitalization in ADHF patients with LVEF <50%.
- PNI outperformed HALP in predicting shorter hospital stays with 77% sensitivity and specificity.
- Elevated SII and SIRI were associated with prolonged hospitalization but had limited predictive accuracy.

## Abstract

Despite evidence on nutritional and inflammatory markers in various conditions, their combined impact on outcomes in acute decompensated heart failure (ADHF) with reduced left ventricular ejection fraction (LVEF <50%) remains underexplored. This study investigated associations between these biomarkers and clinical outcomes in ADHF patients with LVEF <50%.

This retrospective study included 232 patients with ADHF hospitalized between January and December 2024. Patients were grouped by hospitalization length (0–5 vs. > 5 days). Nutritional and inflammatory biomarkers were calculated from admission blood samples and analyzed with demographic and clinical characteristics using appropriate statistical methods.

Patients with prolonged hospitalization (>5 days, n = 109) had higher Urea, Creatinine, CRP, TroponinT, WBC, Neutrophils, SII, and SIRI, and lower Albumin, Sodium, Hemoglobin, Lymphocytes, HALP, and PNI compared to shorter stays (0–5 days, n = 123; p < 0.05). All in-hospital deaths occurred in the prolonged group (n = 15; p < 0.001). Multivariate logistic regression identified higher HALP (OR = 0.987, 95% CI = 0.974–0.999, p = 0.033) and PNI (OR = 0.715, 95% CI = 0.644–0.793, p < 0.001) as independent predictors of shorter hospitalization. ROC analyses demonstrated PNI (cut-off = 40.51, AUC = 0.85, sensitivity 77%, specificity 77%) outperformed HALP (cut-off = 0.3585, AUC = 0.679, sensitivity 63%, specificity 63%) in predicting shorter stays. SII (cut-off = 983.60, AUC = 0.622) and SIRI (cut-off = 2.917, AUC = 0.626) were associated with prolonged hospitalization but showed limited predictive accuracy.

In ADHF patients with LVEF <50%, poor nutritional status (low HALP and PNI) and high inflammatory burden (elevated SII and SIRI) were linked to prolonged hospitalization. Higher HALP and PNI predicted shorter stays, with PNI showing superior discriminatory power, suggesting nutritional optimization may improve outcomes.